Extubation Quality Research Articles

Effect of diltiazem and lidocaine on arterial pressure or heart rate and the quality of extubation in patients undergoing uvulopalato-pharyngoplasty

Objective To evaluate the effect of diltiazem and lidocaine on arterial pressure or heart rate and the quality of extubation in patients undergoing uvulopalatopharyngoplasty. Methods Sixty patients were randomly divided into 4 groups: In the control group patients were given saline; in the lidocaine group patients were given 1.0 mg/kg lidocaine; in the diltiazem group patients were given 0.2 mg/kg diltiazem; and in the lidocaine plus diltiazem group patients were given 1.0 mg/kg lidocaine and 0.2 mg/kg diltiazem. These drugs were given 2 min before tracheal extubation. Values for SBP, DBP, and HR were recorded, on arriving at the operating room, immediately at the end of the surgery, at the time of injection of the study drugs, at tracheal extubation, at 1 min and 5 min after extubation. The quality of extubation according to the Sebel's grading scale were compared among the 4 groups. Results During extubation in the control group HR, SBP and DBF increased significantly when compared to baseline levels. Both lidocaine (1.0 mg/kg) and diltiazem (0.2 mg/kg) successfully alleviated these increases. The suppressive effect of diltiazem was greater than that of lidocaine. The combinative use of the two drugs minimized the increases. The administration of lidocaine significantly suppressed bucking or coughing compared with the other groups. Conclusions The pressor responses and tachycardia occurring in patients with uvulopalatopharyngoplasty during emergence from anesthesia and tracheal extubation, can be easily blocked by a bolus dose of 1.0 mg/kg lidocaine, 0.2 mg/kg diltiazem or the combinative use of the two drugs. And the concurrent use of lidocaine and diltiazem alleviated the hemodynamic changes more obviously.

COMPARATIVE STUDY OF LIDOCAINE AND VERAPAMIL ON THE HEMODYNAMIC CHANGES AND QUALITY OF EXTUBATION

S360 INTRODUCTION: Rises in heart rate and arterial pressure during emergence from general anesthesia and following tracheal extubation are well documented [1,2]. These responses may produce myocardial ischemia or infarction in susceptible patients. Lidocaine [2] has been shown to attenuate these responses [2]. Verapamil has been used to attenuate the physiologic changes associated with tracheal intubation [3-4]. We conducted a randomized, double-blind study to examine the effects of intravenous (i. v.) verapamil (0.1 mg/ kg) on hemodynamic changes during tracheal extubation and quality of emergence from anesthesia The effect of verapamil was compared with that of lidocaine or saline. METHODS: Seventy Five adult patients undergoing elective surgery requiring general anesthesia and controlled ventilation were studied. In all patients anesthesia was induced with thiopentone 4mg/kg and vecuronium bromide 0.1mg/kg, and maintained with halothane 0.5-1% and 60% nitrous oxide in oxygen. At the end of surgery, prior to reversal of muscle relaxant halothane was discontinued and 100% O2 was administered. 2-3 minutes after reversal (with neostigmine 0.04mg/kg and atropine 0.02 mg/kg) of neuromuscular blockade (NMB), patients received one of the following three study drugs:Group S =Saline10 ml (control, n 25, 41 +/- 11 Yrs, 52 +/- 8 Kg). Group L = Lidocaine 1mg/kg (n 25,37 +/- 11 Yrs, 51 +/- 10 Kg). Group V = Verapamil 0.1mg/kg (n 25,46 +/- 9 Yrs, 53 +/- 7 Kg). Heart rate (HR) and mean arterial pressure (MAP) were recorded: [1] immediately prior to reversal of NMB; [2] immediately prior to administration of the 'group' assigned drug; [3] one minute after extubation; [4] At five minutes after extubation. Quality of extubation was graded according to the Sebel's grading scale: Grade I - Smooth extubation, no bucking or coughing. Grade II-Slight coughing or bucking. Grade III- Moderate bucking or coughing or laryngeal spasm. Statistical analysis was performed using SPSSver6 Chicago software. Mean (SD) were recorded. ANOVA was used to determine differences between groups and post hoc analysis by Bonferroni t test was performed for multiple comparisons against the saline control group. Mann-Whitney U - Wilcoxon Rank Sum W Test and t test were performed as indicated by data. P<0.05 was taken as significant. RESULTS: All groups were comparable for age, weight and sex ratio. There was no difference in HR and MAP between groups before induction of anesthesia, at the end of surgery and after reversal of NMB. Lidocain group provided hemodynamic stability better than Verapamil group and also was statistically significant in respect to quality of extubation (with 80% grade I extubation in *Lidocaine 20/25 group compared to 36% in Verapamil 9/25 group and 28% 7/25 in saline group). *P = 0.0008 (Table 1)Table 1CONCLUSION: Results of the study show that lidocaine 1 mg/kg attenuates the hemodynamic response to emergence and tracheal extubation and also lidocaine is superior with respect to quality of extubation in these dose regime as compared to Verapamil 0.1 mg/kg.